Insurance payers with unique claim filing rules

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Blue Cross Blue Shield
Medicare or Medicaid
Hudson Health
UnitedHealthCare
Value Options
Magellan Behavioral Health
National Government Services (NGS)
Highmark

 

Blue Cross Blue Shield

1) Send claims to the correct BCBS payer

BCBS payers require you to submit claims to the BCBS payer in the state where services are performed. So if your service facility is in Arizona but you have a client with a BCBS of Ohio plan, you should file the claim with BCBS of Arizona.

2) Find out if your client's BCBS plan uses a separate payer for mental health claims

Some Blue Cross/Blue Shield insurance plans require mental health claims to be submitted to a separate payer. For instance, Capital Blue Cross (Payer ID 23045) frequently requires mental health claims to be submitted to Magellan Behavior Health (Payer ID 01260)

Call your client's BCBS insurer to confirm where they would like electronic mental health claims sent.

 

Medicare or Medicaid

1) You must be credentialed

You must be credentialed with Medicare or Medicaid before they will accept claims from you. (This is a separate process from enrolling through SimplePractice.) Credentialing is a process you manage directly with the payer. If you are not credentialed directly with Medicare or Medicaid, they will not accept your claims or enrollments through SimplePractice.

2) File with your correct NPI

If Medicare has 2 NPI numbers on file for you ( a billing NPI and a provider NPI), be sure to use your billing NPI when filing CMS claim forms. Read this article for details: Populate your billing NPI to CMS claim forms.

 

Hudson Health

If you have a client with a Hudson Health insurance plan, you will most likely need to submit your claims for mental health services to Beacon Health Strategies with payer ID: 43324. In many cases Hudson Health contracts with Beacon Health Strategies to pay mental health claims. 

Call the payer to confirm this and read the client's ID card. Call Hudson Health to confirm which payer you should submit to for online mental health claims: https://www.hudsonhealthplan.org/contact/provider-relations/

 

UnitedHealthCare

ValueOptions is the payer for mental health claims for many UnitedHealthCare plans.

If your client has UnitedHealthCare printed on his/her insurance card it's best to call the number on the card to confirm whether mental health claims should be sent to UHC or ValueOptions.

Sometimes, mental health claims submitted to ValueOptions will require an alternate member ID from the one printed on the client's ID card. Be sure to ask the insurance company what member ID should be used for submitting mental health claims to ValueOptions

 

Value Options

Value Options sometimes pays out mental health claims for other insurance plans (United Health Care). If your claims are to be submitted to Value Options, it's important to know that Value Options uses a slightly different Payer ID with SimplePractice than they use with other online claim filing systems.

If you have previously filed online claims with Value Options under the Payer ID VALOP, you will now be submitting claims to Value Options under the Payer ID 43307, or 00813, or one of the other Value Options payers in SimplePractice. Search for "Value Options" to see the options and find the right payer for you.

 

Magellan Behavioral Health

File with the correct Magellan payer

There are two main Magellan payers depending on whether or not the client is an Aetna subscriber or not. 

If the client is not an Aetna subscriber then file your Magellan claims here:

Payer ID: 01260 - Magellan Behavioral Health (All Non-AETNA Subscribers - Provider ID Required)

If the client is an Aetna subscriber then file your Magellan claims here:

Payer ID: 60054 - Magellan Behavioral Health (For Dates of Service 1/1/2006 and After - Provider ID Required - AETNA Subscribers only.)

Be sure to read the client's insurance ID card to find out whether the client is an Aetna subscriber. If you're still not sure, you can run a coverage report, or you can call the phone number on the ID card.

If you file with the wrong Magellan payer, your claim will be rejected and an error message delivered: "Payer Claim Office Number is missing or incorrect. Verify with Authorization of Care letter or your authorizing Service Center. If the number was entered correctly Magellan is not the payer."

 

If you submit Magellan claims in California...

If you're a provider in California and you're submitting electronic claims to Magellan Behavioral Health (payer ID 01260) you will need to make sure the payer's address is indicated at the top of the claim form as: 

P.O. Box 710400
San Diego, CA 92171-0400

You can modify the address that populates to claim forms by following the instructions in this article: Add and edit an insurance address for filing claims.

 

National Government Services (NGS)

If you have Medicare clients on a National Government Services insurance plan, you will file those claims with the in-state Medicare payer.

So if you have a client on an NGS plan and you practice in New York, you'll file this client's claims with Medicare of New York (payer ID: NYMCR).

 

Highmark in Pennsylvania

If you're in Pennsylvania and your local Blue Cross Blue Shield payer is Highmark, you can file claims with either of the Highmark payers listed in SimplePractice: 

54771 - Highmark | Highmark PA

PABLS - Blue Cross Blue Shield of Pennsylvania Central Highmark

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